Adoption Application
Please fill out application as complete as possible. All incomplete Applications will not be evaluated. DO NOT fill out this application if you are not seriously interested in adopting a dog. You MUST be 18 years or older to adopt a dog. Thank you for your consideration. *Denotes a required field
Full Name *
Email *
Home Phone *
Alternate Phone
Street Address *
City *
State *	Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code *
What are your major cross streets? *
What age of dog are you looking to adopt?	Puppy (8 weeks-6 months) Adolescent (6 months-2 years) Adult (2-8 years) Senior (8+years)
What color do you prefer?	Blue Red No Preference
What Gender are you looking for	Male Female No Preference
Would you consider an Australian Cattle Dog mix or other Herding type dog	Yes No Maybe
Is anyone in your household allergic to dogs?	Yes No
How many Adults live in your home? *
How many children live in your home? *
What are their ages?
Has everyone agreed to add a dog to the family?	Yes No
If you answered No above, then please explain why?
Do you currently have pets?	Yes No
If you answered yes above, please list (1) Name, (2) sex, (3) Age and (4) Breed of every pet in your household.
Are your pets all current on their vaccinations?	Yes No
Are your pets altered? (Spay or neutered)	Yes No
If your pets are not altered or not up- to- date on vaccines, please explain why:
Do you have a Dog Door?	Yes No
If you don't have a dog door, would you consider installing one?	Yes No
If you answered No above, then please explain why?
Do you have a pool?	Yes No
If you have a pool is it fenced?	Yes No
Do you own your home?	Yes No
If you do not own your home, can you provide us with a letter from your landlord saying dogs are allowed at the residence?	Yes No
What type of residence do you live in?	Single family home- Tract Home Single Family Home with Land Mobile Home in Park Mobile Home with Land Apartment/Townhome/Condo with Yard Apartment/Townhome/Condo without Yard
What type of fencing, how tall and is it fully contained? *
Would you consider adopting a special needs dog?	Yes No
What type of Special needs are you willing to consider for adoption (please check all that apply)?	Deaf Blind Incontinent Fear Aggressive Cat or Small animal aggressive Fearful/Submissive Dog Aggressive In need of Obedience Training Not Housebroken Dominance Issues Medical Care Needed Prescription Meds or Vitamin Supplements I'd like to learn more
How long will your new dog be left alone during a typical day?	0 Hours 1-3 Hours 3-6 Hours 6-9 Hours 9 Hours Plus I work two jobs
Where will your new dog be kept while you are away?	Inside Only -free run of house Outside Only-no access to house Inside/Outside with dog door Crate Outside Kennel or Run Outside Cable or Chain Laundry Room or other Small Room Garage Access Only
Where will your new dog sleep?	Inside Only -free run of house Outside Only-no access to house Inside/Outside with dog door Crate Outside Kennel or Run Outside Cable or Chain Laundry Room or other Small Room Garage Access Only
Are you familiar with Crate Training?	Yes No I'd like to learn more
Are you willing to have a New Hope Cattle Dog representative/volunteer visit your home before adoption? *	Yes No
If you answered No to having someone visit your home, then please explain why not:
Are you willing to take your new dog to Obedience Classes?	Yes No
If opposed to taking your new dog to Obedience Class, Please explain:
Why do you want a Cattle Dog?
Have you ever owned a Cattle Dog or Cattle Dog mix?
If you have owned a Cattle Dog or a Cattle Dog mix, where are they now?
If you have never owned a Cattle Dog or even if you have , please relate your experiences with the breed: *
What Research have you done on this breed (please check all that apply)?	None Read ACD FAQ by Mark Abbott Reasearched History of Breed Have Owned Breed Read Books specifically about breed Have trained breed Have read articles from Cattledog.com Have read New Hope site from top to bottom Have read articles from other we sites
Please describe what a typical day in the life of your new dog
Who is you current Veterinarian (please include Vet Name,Clinic Name, Address and Phone Number *
Can we contact your Veterinarian for a Reference?	Yes No
What type of Cattle Dog areyou looking for (Please check all that apply)?	Working Dog Agility Competition Fly ball Competition Personal Protection Search and Rescue (Tracking) Companion for Child Companion for Adult Companion for Pet Dog to go to work with you Best Friend Outside Only (Back yard) dog
What kind of activities do you and your family participate in regularly that the new dog would be involved in (please check all that apply)	Hiking Bike Riding Camping Running or Jogging Walking Dog Parks Play Dates with other Dogs Movies or TV watching Traveling via RV Traveling via Airplane Boating Home Schooling or Daycare Activities with Kids Dog Sports Dog Training
How would you rate your family"s overall activity level?	Never Active Active 1-2 times per week Active 3-4 times per week Active 5-6 times per week Active Daily Active only on Weekend
How do yu plan on transporting your dog in your vehicle (please check all that apply)?	I don't plan to transport Open Bed of Truck Free in Backseat Crated in Vehicle Teathered/Tied/Chained in Open Bed of Truck Free in Enclosed Bed of Truck Seat belted in vehicle
What do plan to do with your dog in the event of a Divorce or separation with your significant other
What would you do with your pets if you had a family member or significant other that become allergic to pets?
What would you do with your pets if you, your spouse or significant other had a job Transfer to a different state?
What would you do if unemployment or a financial difficulty arose that forces you to move into a smaller home or apartment?
What would you do if the new dog is destructive in your home or yard?
What would you do if your neighbors complained that your dog barks excessively in the backyard or house?
What would you do if your dog needed emergency surgery or care over $1000.00
What would you do if your dog needed Hospice Home or Long term care (i.e. help going to the bathroom,help eating,IV fluids,injections,etc.)? *
What would you do if your dog bites someone?
What would you do if your new dog bites you?
What would you do if your new dog fights with other pets in your home or new pets brought into your home?
Have you ever had to relinquish a pet (i.e. take to the pound, give to family /friends)?	Yes No
If you answered Yes above,please explain the circumstances:
Have you ever been involved in breeding dogs?	Yes No
If you answered Yes above,please explain:
What are the specific names of the Dog (s) from our website that you are interested in ? (please list all). *
References:	Please provide three refeerences for your application to be considered:
Name: *
E-mail address:
Phone Number: *
Name: *
E-mail address:
Phone Number: *
Name: *
E-mail address:
Phone Number: *
Additional Comments
Please tell us what days and times work best to schedule a home check: *

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